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Home My WebLink About16-17713 � � � CITY OF ZEPHYRHILLS 5335-8TH STREET r' , • (si3)�so-oozo 7713 BUILDING PERMIT i PERMIT INFORMATION LOCATION INFORMATION � Permit N,umber: 17713 Address: 5714 19TH ST � Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est� Value: Parcel Number: 11-26-21-0010-07800-0090 Improi�r. Cost: 12,395.00 OWNER INFORMATION I Date�'ssued: 10/12/2016 Name: KARL & FAY KINGERY ' Total Fees: 100.00 Address: 5714 19TH ST Amount Paid: 100.00 ZEPHYRHILLS, FL. 33542 , Date Paid: 10/12/2016 Phone: Wor,'k Desc: REROOF SHINGLE � CONTRACTOR S APPLICATION FEES TLC ROOFING LLC REROOF RESIDENTIAL 100.00 � 1\ / 1 ^�/ D � � -o� � Ins ections Re uired ' DRY IN ROOF INSP TAPE JOINTS ROOF INSP FINAL II i REINSiPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or II first reinspection,whichever is greater,for each such subsequent reinspection. NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that may b�e found in the public records of this county, and there may be additional permits required from other governmental �� entities such as water management, state agencies or federal agencies. "Wa�ning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing,consult with your lender or an attorney �� before recording your notice of commencement." Complete Plans, Specifications Must Accompany Application. All work shall be performed in accordance with �� City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. II O CCUPANCY BEFORE C.O. I - ,� � - ./� iCONTRACTO SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER I � � � . ° ' I ��Twi�. �� . ow.so �. � �� 1�YPES . e,�...�...�. FF�E ESTtI►IATES CI�U..I.nA�icE THURtSTOW" . Office: 352-437-4073 Cel1: 352�650-7101 , I PROPOSAL SUBMfrTED TO WORKED TO BE PERFOFiMED AT \ Vame II Vl • Street �treet �� t � City , "ity Z�,'�.v�h ,� / � State � Zip � . �ate �� Zip�`�� -/ I Owner of Pr+opeity " Phone iVumbei` ��x Phon�Number Fax iN er�ta.y pilopose to•fumish ail the Fnaterials and pecfoPm/�II#he labor n�cessary for the completion of: �Reenove exis�ng shingle roof �f place bad fascia boards at$ per foot � Instail feet of rid e vents ] move exilsting•built-up r . f ,� 9 y �'Dry=in�witf� O 15:Ib. �D��Ib. D install modified tiitimen(granulate�torch down roofing /' I� ' �(Install.new �aivanizedavailey-metal black,white or other color . L�Instali new lead.600ts� 0 stall 25 yr.fungus resistant 3-tab shingles Lq Instell new lexha_ust vents � tnstall 30 yr,fungus resistarrt dimensional shingles f9'�nslali new Ildrip edge,_ _ color ❑Shingle manufacturer color �nstail,new�fiashing•as needed O I stall TPO,white rubber�zed roofing membrane �Replace� ood:at�,� J��-� persh�et ��r . ❑Re�ir rotten trusses at$ per foot � s �' '1Noodwork ils an addidonal charge,see pricing above II Ail material i�guaranteed to be as specified;and the above work is to be performed is accordance with the drawings and specifica- tions submigtii d for above work and cumpleted in a subsiantial.workmanlike mannar for the sum of$�3 9 S - with payments to be made,as follows. Qavment,due ir�ful� on com�letion, unle$s otFeerw►ise not�o 1°hank Y��ae Creditcards acxepted,additionai 2.8%.charge. Any alteretlon�or�deviatl6n.hom.abcve specl,Qcatlons inwhring_extra.cosfs will - he exectited oniy�upon.written oidera,end aylll.becoine an eutra cl�ige oder and ___ abave;the.estimaf e.AU.agreemerAs contli�gent,upon sVikes,acctdeiite,or delays �((j�@P/A etlt begond-our,contrcl.Owner.to;cerry 8ne,tamedo epd other�necesaery Irisurance 9 upon above workJ�Workers'_Cnrnpeneation arM Publlc LiabNity insurartce an above Note: This proposal may be withd ravun �y us if not accep#ed work,to be.mken,�:out by Rooflng Csmtractor, � within days. Client gives ipermission to drive on driveway to deliver materials. f II ACCEO''T�1iVCE OF PROP.OSAL The abov�prices,spec�cations and conditions are satisfactory and are;hereby accepted.You are authorized to do the work as specfied.�J l have read,4he:baCk of this Proposa!/Contcact,which contains Florida Statues 713.00�-713.37.Payment witl be rnade as outlined abOve. Accepted �ignature Date I � . Signature � �� . 1 i � : � � �� NOTES TO CLOSER I File No.:16-4747 IBuyer:Karl D.Kingery and Fay I.Kingery I � Clasing Date: 9/011L016 Funding Date: 9/O1/2016 Please sign in BLUE INK and EXACTLY as name appears. i Please obtain Photo ID of all Parties. Please obtein a cashier check or wire confirmation from Buyer in the amount of$26640.33. Please sign 5 copies of the ALTA Statement and FL [nsurance Premium Disclosure, each as an original. We wiU fund and authorize the key to be released upon our receipt of the Buyers cash to close, signed documents,the Seiler signed HUD and Funding Authorization from the Lender,if applicable. **Give the package to Aaron the realtor so that he can drive originals back to me*** liz.minnda@buyerstitle.com or (954)602-9618 Please overnight the documents to the foltowing address: Buyer's Title,Inc. Attn: Liz Miranda 100 N W 70'h Avenue Plaritation,FL 33317 � **PLEASE COlVF1RM THIS IS THE ADDRESS THE BUYER WANTS THE DEED AND I OWNERS POLICY SElVT TO. 1F NOT PLEASE FILL [N THE CORRECT ADDRESS iBELOW'" Karl D.Kingery and Fay 1.Kingery 5714 19th St, Zephyrhills,rL 33542 Fill-in correct address if above is incorrect: Please check one of the[ollowing property types: Investment Property Homestead Property 1� Notes to Post Closing , i -------__------_ __.__-_-- ------____---------- ---- . -- - - - --- - -- -- -- i ------ - ---- -------------- -- � C Ios i n g D i s c I os u re This forrn is a statement of Tnal loan temrs and closing costs. Compare this , tJocumertt with your Loan Estimafe. Closing Information Transaction Information Loan Information Date Islsued 09/01/2016 eorrower Karl D Kingery Loan Term 30 years Closing Date 0910112 0 1 6 Fay I Kingery purpose Purchase 5526 6tfi Street Disbursement Date 09I01l2016 Zephryhills,FL 33542 Product Fixed Rate Settie��ent Agent Buyers Title,Inc. Seller FANNIE MAE Flte it 16-4747 5714 19TH ST Loan T e - ZEPHYRHILLS,FL 33542 yP ❑Conventional�FHA Prope 5714 19th Street O VA D ZEPHYRHILLS,FL 33542-4437 Lender Universal American MoAgage Company,LLC Loan ID# D002842870-40 Sale Prke 5115,500.00 MIC tt 093=8542470 •• Can this amount increase after closing? Loai�Amount $96,153 NO Inte est Rate 4.000% NO Molnthly Principal 8lnterest $459.05 W NO See I�rojected Paymenfs befow lor your Esfiil ated Tota!Monthly Paymen! Does the loan have these features? Pre�payment Penalty NO ii Halloon Payment NO �� • � Pa��rment Calculation Years 1-11 Years 12-30 Pi'incipal&Interest $4gg.p5 $459.05 II Mortgage Insurance + 62.50 � -- El�timated Escrow + 333.83 + 333.83 �ount can increase over time E timated Total $855.38 $792.88 �onthly Payment This estimate.includes In escrow? Estimated Taxes,Insurance L; Property Taxes YES 8�Iqssessments $333.83 (}�; Homeowne�'s Insurance YES A�ount can increase over time a rnonth i._l Other: S i�e psge 4 tor defails See Escrow Account on page 4(or details. You must pay for,other property costs separafely. �� • � CI osing Costs ��,�50.25 Includes$4;347.25 in Loan Costs+$5,848.OQ in Other Costs-$45.00 in Lender Credits.See page 2 fordetails. CII sh to Close �26,640.33 Includes Closing Costs.See Cafculating Cash to Close on page 3 for details. � K�K � � CL�SING DISCLOSURE PAGE 1 OF 5 •LOAN ID�.0002842870-40 Wo�ers Kluwer Financial Services 2016090115:1,7.3176-N2015t724Y 0002842870 �3/P016 -----.....__--I--_—____.�...._ Clos;ing Cost Details Borrower-Pald Seller-Pafd Paid by •- � At Closfng eefore Closing Al Ciosing eefore Closing Others A.Odgfnation Charges 5870A� _ __ _ _ _._ . ' °/q of Loan Amount(Points) ._. ^ .. l... _ ... .-- -. .._ . .. . -- Protessing._._ . 5420.00 � Undenvritin 5450.00 E i _. 9-----....--- -... . _. . _ � , ----• -- - _ . .. i � •--_._._. . --_. I . -�-- --- ------- ..-.. ... _.... . .__ ---.. . _--.. ... B.Servlces Horrower DEd Not Shop For 52,281.25 _ __,____._ Appraisal to Wiliiam Ailen Moores Sr. 5470.00 __ _,_, ApRraisal Final Inspection 5150.00 ._ � Flobd Certification to CoreLogic Flood Services S7.50 . M��gage Insurance to Federel Housing Admin. S0.75 _ ,__^_____ _ _ M i gage Insurance - to Federal Housing Admin, 51,653.00 ' : _ „ C.Se, Ices Boaower Dld Shop For 51,196.00 __ ,__ __ ----�••_ --�---... _... . --- • ---�-- - -- • Tille-Lenders Tdle Insurance Io.Buyers Title.Inc i_ 525.00 � Tdle•Municipal Lien Search to Lien Search Pr S85.OD : I Tdte•Recording Servkes �� to Buyers Title,Inc $67.75 _. _.. - - • � Titte•Settlement Agent Fee to Buyers Title,Inc 586�.00 �-•- ------- --- - - --••• ---- • •- __. . - ---•- Tit�e-Title Endorsements to Old Republic Nalional TiUe Insurance 525.00 � .., i ----------- � ---- • _. _ . - • ---- _:�,Tit�e.•Title Searoh __T__to Buyers Tiue,�nc szeo.ou , � ___...._ , _._..._.._----------__._--�---------�- - --- - •- ---- -- - -- ... - � � D.TO,TAL LOAN COSTS(Borrower-Patd) 54.347•25 Loan Costs Sublotals(A+B+C) S4,347.25 ! 50.00 , _�._---�ii'--.. _ -._..._..__.--•-- - ..._..- - ._ __ . _-. ---. ...__ ._. ._�. .. • . E.Taiies and Other Govemment Feea 51.502.01 ,._,_ R�ecording Fees Deed: Mortgage: 5164.50 _______ _ . - -� -- --- City Transfer Fee lo Clerk of the Court $19z•3� , . Cily/County Tax Stamps lo Clerk ol the Court 5336.70 . .,____ � Document Stamps on Deed lo Clerk of the Court 58Q8.50 F.PrpPaids 51,77t.00 - -,-- - Homeowner's Insurance Premium(0 mo.)fo AMERICAN INTERGRITY 51.771.00 � _ . T�rtgage Insurance Premium( mo.) . __..._. ... P�epaid Interest(50.00000 per tlay from to ) , _- _ .. _ ...:..:i[°PertYTaxes( _mo.) ._,._. • • -- --•-- - G.Initlal Escrow Payment at Closing 52,234.99 SO.DD . 50.00 50.00 F�omeowners ins.urance` 5147.58 per month for 3 mo. 5a42.74 ; . ____T,__ _ . Mortgage Insurance 562.50 per month_ for 0 mo. � ___. __ ___._ ___._ .________. -- --- - . _... _ � •- "" property Taxes 5186.25 per monih for 72 mo. E2,235.00 � ;., -�----�-----__.__.._.._----._..... . ---� �- --_ . ,..--- „ggregateAdyustment -$442-75 � H.Other 5340.00 - - -- --- ____�... �eal Estate Commission ___ to Bingham Reatty,Inc 53.465.00 _ �_ . � _ - - �-- • _ Real Estale Commission lo BHHS Florida P�operties Group 52,887.50 . _ - -�----•-•--. . _ . ._.._ .. . ....__.. . - _.. _.__ Seller rep/Gosing Coordina6on fee lo Old Republic National 5275.00 : �Survey-�-------- ••--- to Targei Surveying •-- $340_00 i'--� . . .`- �-_--__ . :• i itle-Owner's Title Insurance to Buyers Titte,Inc ^, __ _ 5652.50 y 00 ona � _ ,.� __._.._.,..�, --•_____ -.-- .. . ._ _ . _ ...-- ---�- I..TOTAI OTHER COSTS(Borrowor•Paid) 55,848.00 Oth'�r Costs Sublotals(E+F t G+H) 55,8a8.00 50.00 - -----..._�_..----. .. _ ._ ._ ..._._ . ._.__..._. .. __...__. . -----., .. .---' -- 1r----- J.70TA1 CLOSING COSTS(Borrower-Paid) 510,150.25 Clo$ing Costs SubtoWls(D+'1) 570,195.25 50.00 57.397.75 LelldOf CfEdilS(lncludes 545.00 uedil fa muease in Gosmg Costs above legal Iund) v_ -545.00 l<�K �� CLOSING DISCLOSURE PAGE 2 OF 5 •LOAN ID q 0002842670-40 WofLers Ktuwer Financial Services 2016090115.1 1.3176-N20151124Y 0002842870 0312016 � -----_.........------- ----- ----------____..._-----------..__._..__._._------ ' ' ' Use this table to see what has changed from your Loan Estimate. � Loan Estlmate ' Flnal ; Did this change? -'--�� •See Total Loan Costs(D)and Total Other Costs(I) •Increase exceeds legal Umits by 545.00. Total Ctosing Costs(J) S9_939� S10,150.25 YES See Lender Credits on page 2 for credit of excess amount. ClosinglCosts Paid Betore Closing � 30 _ _ 5o NO , II Financed ^ � •You inGuded these Closing Costs in the loan amount,which increased the Closmg Costs , (Paid from your Loan Amount) ; , -51,819� __-51.653.D0 YES loan amounl � _ _ - 1i - Down PaymenUFunds trom Borrower ' S21,000� 521,000.00 NO __ _ ___ .___._,_ _._--•-- - — - ' ----- �- .— Deposi� I SO -51,000.00 YES •You increased Ihis payment.See Deposit in Sectlon L _ __ - ._.�...I� . .__....,_. _ ._._ _... ._. .---- - . _.... ----.. __ --.� Funds;lor Borrower , SO� g0 NO .__-_.f-------- •- �--- !---• ._ - --•�----�-•— ---- ----- ---- �--------- Setler Crediis -5653; 50 j YES •See Seller Credits in Sectlon L _ _ Adjust�ments andYOther Credits i 50 j -51,856.92'I YES •See details in Sections K and L Cash t�o Ctose ; 528,466,. 526,640.33 y • ' Use this tabte to see a summary of your transaction. BORROWER'S T}2ANSACTION SELLER'S TRANSACTION K.Duu irom Borrower at Closing 5125,670.98 M.Due to Seller at Cfosing S'f15,500.00 5ale Price of Froperty 5�15.500.00 Sale Price of Property 8115,500.00 . Sale Price of Any Personal Property Inctuded in Sale Sale Price o(Any Personal PropeAy Inctuded in Sale Closing Costs Paid at Closing(J) 510:150.25 . 1 Adjustmenis ad��SSSI1tments for Itams Pald by Seller in Advance AdJustments tor Items Patd by Seller In Advanco CitylTown Taxes 06130/16 to 12131l16 520.73 CityfTown Taxes 08/30/16 to 72/31/16 520.73 : Counry Taxes to Counly Taxes to Assessments to Assessments to L.P�Id Already by or on Behalf'of Borrower at Closing 599,030.65 N.Due from Soflor at Closing 57,397.75 Oeposit 51.000.00 • ' Excess Depasil . �oan Amount $96,153.00 Closing Costs Paid at Closing(J) _ _ 57,397.75 '.. II xistirtg Loan(s)Assumed or Taken Subjeet to Existing Loan(s)Assumed or Taken Subject lo � - �� PayoR of First Mortgage Loan • 5eller Credit PayoH ol5econd Mortgage Loan Othqr Credits Borrower Deposit wl Lender 5425.00 _ Seller Credit AdJustmonts Adjustments for Items Unpaid by Selier Adjustments fo�Items Unpaid by Seller . ICify/Town Taxes to • Cily/Town Taxes to _ _.__ __, ' County Taxes O7l01l16 to 09/01/16 51.452.65 County Tazes 01/01/16 l0 09/01/16 $1,452.65 '' I ssessments to Assessments to CA�CULATION CALCULA710N Total Due from 8orrower at.Closing(K) 5725.670.98 Total Due to Selier at Closing(M) 8115,500.00 To�tal Paid Already by or on Behail of Borrower at Closing(L) -599,030:65 Total Due trom Seller at Closing(N) -87.397.75 Cash to Close�From�To Bortower 526,640:73 Cash 0 From�7o Seller 5108,102.25 KDK � � � CLOSING OISCLOSURE PAGE 3 OF 5 •LOAN ID#0002842870-40 VJo�lers Ktuwer Financial Services 201809U715.1 7.3176-N20151124Y 0002842870 0312016 I -- --- - - I - Additional Informatioo� About This Loan �i .. � . Assum�tion Escrow Account 1f you sell or transfer this property to another person,your lender For now,your loan � will�allow,under certain conditions,this person to assume this � will have an esuow accounl(aisa called an"impound"or"trusP' loan on the original terms. account)to pay the property costs listed below.Without an escrow ❑ wiil not allow assumption of this loan on the original terms. account,you would pay them directly,possibly in one or two large payments a year.Your lender may be liable for penalties and interest Demand Feature for failing to make a payment. Yourloan 0. has a demand feature,which permits your lender to require early Escrow repiayment of the loan.You should review your note for detaiis. Escrowed sa,005.98 Estimated totai amount over year 1 ior � does not have a demand teature. Property Costs your escrowed property costs: over Year 1 �� Nomeowners Jrtsu2nce.Counry.P�Operty Late Payment If your��payment is mare than i5 days late,your lender will charge a late Tax fee of 4.000 peroenl ol the principa!and interest past due. Non-Escrowetl 50.00 Estimated total amount over year 1(oc Property Costs your non-escrowed property costs: Negatrve Amortization(Increase in.Loan Amount) over Year t Underlyour loan terms,you O are scheduled to make monthly payments that do not pay all ot the interest due that month.As a resuli,your loan amount wUl increase (negatively ainortize),and your loan amount will likely become larger You may have other properry costs. than your onginal loan amount.Increases in your loan amount lower ��;�;al Escrow 52,23a.ss A.cushion for tne escrowaccountyou the equity you have in thiS ptopefty. payment pay at Gosing.See SecGon G on page 2. ❑ m�ay have monthly payments that do nOt pay all of the interest due �onthly Escrow 5333.83 The amount included in your totai th'�t month.If you do,your loan amount w�l increase(negativefy payment montny payment. arrortize),and,as a result,your loan arttount may become Iarger th�an your original loan amount.Increases in your loan amount lower thii equity you have in this property. ❑ will not have an escrow account because O you declined it�your � d0 not have a negative amortization feature. lender does not require or oHer one.You must directly pay your property costs,such as taxes and homeowners insurance.Contact PaRi�21 Payments your lender to ask if your loan can have an escrow account. Your'lender . - ----. .---, • � O rr�ay accept payments lhat are less than the tutl amount due No Escrow � __ (partial payments)and apply them to your loan. Estimated Estimated tota�amount over year t You 0 rt�ay hofd them in a separate account until you pay the rest of the Properry Costs must pay these costs direGly,possibly payment,and'then apply the full payment to your(oan. over Year t in one or two large payments a year. I � does not accept any partial payments. Escrow waiver Fee If thi�loan is sold,your new lender may have a different poficy. Security Interest /n fhe future, You�re granting a security inlerest in Your property costs may change and,as a result,your escrow pay- the rqal property localed at:57i4 i9th Sheet,ZEPHYRNILLS,FL ment may change,You may be able to cancel your escrow account, 33542-4437 but if you do,you must pay your property costs directly.If you fai� to pay your property taxes,your state or local government may(1) impose fines and penalties or(2)place a tax lien on this property.If you fail to pay any oi your property costs,your tender may(1)add the amounts to your loan balance,(2)add an escrow account to your loan,or(3)require you to pay fo�praperty insurance that the tender You�nay lose this properiy if you do not make your payments or buys on your behalf,which likely would cost more and provide fewer salisfy other obligations for this loan, be�efits than what you could buy on your own. K�� CLOSING DISCLOSURE P0.GE 4 OF 5 •LOAN ID t10002842870-40 Wo ters Kluwer Financial Services 2016090715.1.1.3176-N20151124Y 0002842870 03/2D16 �. • • � • Total df Payments.7otal you will have paid after Appraisal you make all payments of principal,interest, If the property was appraised for your loan,your lender is required to mortg�ge insurance,and loan costs,as scheduled. $175,356.49 g�ve you a copy al no additional cosf at least 3 days before ciosing. il If you have not yet received it,please contact your lender at the info�matiori listed below. Finance Charge.The dollar amount the loan will $79 901.49 Contract Details cosf yli u. See your note and security instrument for infortnation about •what happens if you faii to make your payments, Amou,lnt Financed.The loan amount available after •what is a default on the loan, payin�your upfront finance charge. $92,760.75 •situations in which your lender can require early repayment of the � loan,and •the rules for making payments before they are due. Annul !Percentage Rate(APR).Your costs over the lo�n tertn expressed as a rate.This is not your Liability after Foreclosure intereii t rate. 4.853°lo If your lender forecloses on this property and the foreclosure does not cover the amount of unpaid balance on this loan, Total Ilnterest Percentage(TIP).The total amount ❑ state law may protect you from liabiliry for the unpaid balance.If you of interest that you will pay over the loan term as a refinance or take on any additional debt on this property,you may per i�tage of your loan amount. 71.869% �ose.this protection and have to pay any debt remaming even after foreGosure.You may.waril to consult a lawyer for more information. IK: state law does not protecty ouu from liatiility for the unpaid balance. Refinance Refinancing this foan will depend on your future finanaal situation, the property value,and market conditions.You may not be able to refinance this loan. QueStlons? If you tiave queslions about Qie loan tertns or cosis on this fortn,use 1he contact Tax Deducdons Information betow.To get more information If you borrow more than this property is worth,the intere§t on the or make a complainl,contact the Consumer loan amount above this property's fair rtiarket value is not deductible Financial Protection Bureau at from your federal income.taxes.You should consult a tax advisor for www.consumertinance.govlmortgage-closing more information. . . . Leniier Mongage Broker Real Estate Broker(By Real Estate Broke�(S) .Settlement Agent Na e Universal American Bingham Realty BERKStiiRE Buyers Title,Inc. Mortgage Company, HATHAWAY I.I,C Ad ss 4600 W.Cypress Street, 38070�DAUGHTERY 1830 BRUCE B 100 NW 70th Avenue Suite.a65 ROAD DOWNS BLVD. Ste.100 I TAMPA,FL.33607 ZEPHYRHILLS,FL WESLEY CHAPEL,FL PlantaGon�FL 33317 33540 33540 NMLS ID 1058 FL Llcense ID 1106080 170101 CQ236513 D005069 ' Co�tact Adam J.Mervine Aaron Tadlock PATTY HURLBURT Liz Miranda V Co tact NMLS ID 208396 Coltact 208396 SL3195440 SL698374 � FL icense.ID ' � •- ---� •. --- - .._._�.--- .._�_._.�....._. Eml il adammervine@eagteh aaron@binghamrealt phurlburt@bhhsflor liz.miranda@buyers m.com yinC.com idaproperties_com title.com Ph�ne (813j 261-7900 (813)312-6085 (813)997-0864 (954)915-8450 . . By"igning,you are only confirtning that you have received this form.You do not have to accept this loan because you have signed or received this form. I � � o� 0�- 12oL� �%" � ` ��u _ o � � � ��.---- l _- -- . . _ ..�� Ka�D Kingery Date Fay I i gery Date CL�SING DISCLOSURE P E 5 OF 5 •LOAN ID q 0002842870-40 Vvo ters Kluwer Financial Services 2016090115.1.1.3176-N20151124Y 0002942870 0312016 � _ .�_ _ __--------—_��» I ------ -------- __---- -- r A d n m Ciosin Disclosu e d e du 9 Date Isll ued 09/01l2016 sorrov�er . _ --- 1 Karl D i�(ingery � ' S526 6�Ih Street �Zephrypills.FL 33542 Fay I Kingery 5526 6�Ih Street Zephryhilis,FL 33542 � I I KD K ��e-� CL SING DISCLOSURE-ADDENDUM PAGE 7 OF 7•LOAN ID#0002842870-40 1Nol ers Kluwer Financial Services 2016090115.1.1.3176-N20151124Y 0002842870 10/2015 .4____—�.---_._._..._�._____�..._�__.__.__.._--.,._. .-----.__��..__...r_..__ ___.�____ I _..._.. i . � \ � � Closing Disclosure Addendum Date Issl ued 09/01/2016 �BortovJler _...._.____.__..�_.. IKad D Kingery 5528 6 I�SVeet ZephrylJ ills,FL 33542 FaylK�m�gery 5526 6th SUeet Zephryhills,FL 33542 I . I � I � � I � �D� �� %� � CLO 1NG DISCLOSURE-ADOENDUM PAGE 7 OF 7•LOAtJ ID#0002842670-40 Woil��t5 Kluwer Financial Services 2016090115.7 1.3176-N20151124Y 0002842870 10/2015 1 � Caosing Disclos�re Clol ing Information Transaction information Dat��lssued 06/2i/2016 eorrower Karl D.Kingery,Fay I.Kingery CIo31ng Date 09/Oi/2�1fi 5526 6th St pis�ursementDate 09/Ol/2016 Zephyrhills,FL 33542 SeKlement Agent Buyer's Title,Inc. Seller Federel National Mortgage Association a File�iA 16•4747 i4221 Dallas Parkway,Suite 5000 Property 571419th St Dallas,TX 75254 Zephyrhilis,FL 33542 Sal�Price 5115,500 Loan Type: F'HA � � . . . 5��,,LLER'S TRANSACTION REAL ESTATE BROKER(B) D�etoSelle�atClosing $115,645.73 Name BinghamRealty,lnc. � •�' Sale PriceofProperty $115,500.00 Address 38070 Daughtery Road � Sale Price of Any Personal Property Induded in Sale Tech Fee 5125.00 Zephyrhills,FL 33540 License ID FL CQ170101 Contact Aaron Tadlock Contact License ID FL SL3195440 Email aaron@binghamrealtyinc.com Adjustments for[tems Paid by Seller in Advance Phone City/Town Taxes to REAL ESTATE BROKER(5) County Taxes to Assessments to Name BHHS Florida Properties Group ! non-advalorem 09/Ol/2016 to 12/31/2016. 520.73 Address 1830 Bruce B Downs Blvd I WesleyChapel,FL 33543 License IO FL CQ236513 Contact Patty Hurlburt � D��e from Seller.at Closing $8,938.68 �onta�t License lD FL SL698374 > Excesz Deposit Closing,Costs Paid at Closing(J) 57,486.03 Email phurlburt@bhhsfloridaproperties.com Exi;ting Loan(s)Assumed or Taken Subject to Phone (813)997-0864 PayoH of First Mortgage Loan SETTLEMENT AGENT PayoR of Second Mortgage Loan fVame Buyer's.Title,.lnc. Address 100 NW 70th Avenue Seller Credit Plantation,FL 33337 License IO Contact Liz Miranda Contact License ID djustments for Items Unpaid by Seller Email liz.miranda@buyerstitle.com City/rown Taxes ta Phone CountyTaxes O1/O1/2016 �a 09/O1/2016 51,452.65 Assessments to Questions?If you have questions about the loan terms or costs on this form,use the contact C�ALCULATION information above.To get more information TI'oItal Due to Seller at Closing $115,645.73 or make a complaint,contact the Consumer Total Due from Seller at Closing $8,938.68 FinanCial ProteCtion Bureau at www.consumerfinance.gov/m ortgage-dosing (�ash�From [�To Seller $106,707.05 `�D �� y�� I.OSING DISCLOSURL• l � PnUI's I OF 3 _._..�--__..______._.,_._._----- -------�._�.� _.__ __.____ C;losing Cost Detaiis �� Seller-Paid '' ' At Closing Be(ore Closing A� OrigfnatfonCharges � %of Loan Amount(Points) �, i I� f I I i . B�. Services Borrower Did Not Shop For I I ' � i I i d.Services Borrower Did Shop For I : Loan Policy Coverage.596,153.00 to Buyer's Title,Inc. $25.00 Title-Endorsement 8.1 to Old Republic National Title Insura � $25.00 �: Title-Endorsement FF9 to Buyers Title E Recording $67.75 � I. N. � , II � . E.Taxes and Other Government Fees �IRecording Fees Deed: Mortgage: ; Ooc Stamos(B)to euvers Title E Recordine j F.Prepaids Hoineowner's Insurance Premium mo.to ': Mortgage Insurance Premium mo.to Prepaid Interest from to � Property Taxes mo.Lo � G.Initial Escrow Payment at Closing Homeowner's In;urance per month For mo. Mortgage Insurance per month for mo. ' • Property Taxes per month for mo. ' i i . i !}d AggregateAdjustment � .Other � � Curetive/Post Contrad Municipal Search Fee to Lien Search Pr i $85.00 : Real Estate Commission to Bingham Realty,Inc. I $3,465.00 Real Estate Commiision to BHHS Florida Properties Group � $2,887.50 Seller rep/closing coordination fee to Buyer's Title,Inc. I $275.00 � Statutory Surcharge to Old Republic National Ttle Insurence I S3.28 ��.Title-Owner's Premium$315;500.00 to Buyer's Titte,lnc. � 5652.50 , � • � ' � i � � II II�•TOTAL CLOSING CO5T5 $7,486.03 $0.00 CLOS WG 1)ISCLOtiURI: �� " 1 6� � �� PAGE 2 OF 3 � i —__ _.�..__._------------__..------ ------------- -.__-------------._......---_.— i Addendum Closing Information: II ate Issued: 06/21/2016 File No: 16-4747 osing D'ate: 09/01/2016 �roperty information: 571419th'St Zephyrhills,FL 33542 7IIransactio�Information: Borrower: Karl D.Kingery Borrower. Fay I.Kingery Ipddress: 5526 6th St Address: 5526 6th St City%ST/Zip: Zephyrhills,FL33542 City/ST/Zip: Zephyrhills,.FL33542 Selter: Federal National MoRgage Association a/k/a Fannie Mae Address: 14221 Dallas Parkway,Suite 1000 City/ST/Zip: Dallas,TX 75254 Loan Costs Setler-Paid At Ciosing Before Closin C.Services Borrower Did Shop For 02 Title-Endorsement 8.1 to Old Republic National Title Insurance Co. Szs.00 p�eC�y� Setier�aid At Closin Before Closin H.Other Ol Curative/Post Gontrect Ivlunicipal Search Fee to Lien Search Sas.00 Professionals,Inc I OS Statutory Surcharge to Old Republic National Title Insurance 53.28 Company , . , . Contacts that coutd not fd are shown in full here. Lender Name Univers@I American Mortgage Company LLC Address 600 W.Cypress Street,STE 465,Tampa,FL 33607 NMLS ID FL License.ID Contact Contact NMLS ID Contact FC License ID Emaif Phone I� � � � �� CLOSING DISCLUSURG PAGL'3 OF'3 Florida Insurance Premium Disclosure&Settleinent Agent Certification Agency File#16-4747 Closing Date: 8/30/2016 i � You are being given this form and certification to explain differences between Federal and Florida law.Federal law requires the costs oFthe policies to be calculated using the full premium for the lender policy.Florida law allows the premium'for the lender's policy to be calculated using a lower rate when purchased along with an owner's policy IFbo[h an owners policy and a lenders policy are being purchased,the ritle insurance premiums on this form might differ from the premiums on the Closing Disclosure.The owner's policy premium listed on the Closing Disclosure will probably be lower than on this form,and the lender's policy premium will probably be highcr. The chart below lists[he amount disdosed by the lender and the premium For the policies being purchased.These amounts include the charges for endorsemen[s to the policies: Closing Dlsclosure Amaunt Florida Premium Bu er + Scller Bu er � Seller (a) Lender s olic : I 35.00 25•00 (bJ Lender's Endorsemen[s 93.75 92.75 (c) Lender's Policy Total: j 117.75 j 117.75 (d) Owner's Policy i G52.50 652.50 (e) �wner's Endorsements: � (� Owrier's Policy Total: 652.50 652.50 Total All Policies c+ : __ 770.25 __ _ .^ 770.25 The total dollar amount for the policies as disclosed on this form should be equal to the total premium calculated using the Florida Insurance Code. The Florida Premium amounts listed above will be used to disburse the funds from the title agency's escrow account to(Name of Insurer)and(Name of Title Agency). The undersigned hereby cer[ify that they have carefully reviewed the Closing Disclosure or other settlement statement form,and tliey approve and agree to the payment of all fees,costs,expenses and disbursement as reflected on the Closing Disclosure or other settlement statement form to be paid on their behalf.We further certify that we have received a copy ofthe Closing Disclosure or other settlement statement. � , ' Zb1 � _— Bfli b�!��e1�4a�'�"g'w�f+Jo:�l�f Buyer�QaT4l��Iff�. [3uycr/I�orrower n ��rc Date Signed as A�+:��n';?-�r�-►-��Gr Federal National Mnrt�i�na at�;t�rl��lon alkla Fannie Mae l�R�►�Ki�6CR'� �e�er Printed Name BuyedBorrower Printed Name ;� � �'�i a� / Seller Signature Date Signed uyerBorrower Si na Gr Date Signed � y %' Seller Printed Name uyerBorrower Pri te ume Settlement Agent Certification 1 have revlewed the Closing Disclosure,�he settlement statement,the lender's closing instructions and any and all other forms relative to[he escrow fund,including any disclosure of the Florida Title lnsurance premiums heing paid,an 1 agree to disburse the escrow Fund in accordance with the terms of this transaction and Florida]aw Settlement Agent Stgnature Da�e Signed t Liz Miranda Settlement Agent Name Florida License Number BuVer's Title,Inc. D005069 Title Agency Holding Funds Florida License Number Form DFS-H1-2146(Effective 10/3/2015 69B-186.008,F.A.C. � - - - � � A erican Land Title Association Final ALTA Settlement Statement-Combined Adopted 05-01-2015 i I il I3uycr's Title, Inc. 100 �IW 70`�' A��enue f'lant�tion, Flol•ida 33317 1'honc: (95�) 915-84�0 / Fa�: (954) 915-9677 Flile No./Escrow No.: 16-4747 Rrint Date&Timet 09/O1/2016 12.32 PM II ��fficer/Escrow Officer: Liz Miranda Settiement Location: 100 NW 70th Avenue, Plantation, Fl 33317 II , I�roperty Address• 5714 19fh St,Zephyrhills, FL 33542 i �uyer. Karl D Kingery and Fay I. Kingery 5Ieller: Federal National Mortgage Association a/k/a Fannie Mae �Lender Univcrsal�lmerican Mortgage Company LLC , I Reference/Loan No:0002842870 Loan Type: P'HA SIettlement Date: 09/O1/2016 Closing(Consummation} Date: 09/01/2016 ' Disbursement Date 09/O1/2016 I �� k.:_;�rr� „:TM- -�.,":aa'_ c+_.�;•�.�:`;�- ^�-_ a:-�;,�.^�_. &�:;� ��,'�' .'m„'e3'�" - .=i.s`. �_' __��„ "A'.',� �F=''' =£�k:`•r ' ''-�:.M.,��-.'.i x� t';�ri., .' . .., .� d_..:�`.._ -�P'`` , i� ��,}�y ,:${ �:�:��i:53^`��'^��+'.;��.�^.z�;`�Xs�'.�:�:.Lp�::z.a.P��,"?�'.'•; t:d._.:r a'�'=}e` `<t�., ti..��4..,��4.".';3:��,�r.'�''.,��'w��"RaZ�?�°��7��!!�?�� :�i+;�t`i�, s..L...:.E .,, .- � . -.. . ..�...:.._T_,. .-,.�:: i.,. - . II . . . .. ��. --� � , ...-,,. . . ,. . ,. , .. . . . ... ,,� ' Selle� � Description ' ' " � Bocrower/Buyer II Debit Credit Debit Credit III Financial II 115,500.00 .5ales Price of Property 115,500.00 II Eamest Money 1,000.00 Loan Amount-Universal American fvtortgage Company 96,153 00 ILLC � I � II � IProrations/Adjustments I 1,45Z.fi5 Property Tax @ 2,1/3.02 p�r 1 year(s) 1/01/2016 to 1,452.65 I I9/O1/2016 I �� Q'opyright 2015 American l.and Title Association. 16-4747 Ill r�ghcs resen,ed. Page 1 of 4 Printed on 09/O1/Z016 at 12.3Z PM —_ �.. _ .. - --._. _ _ _ . _.._ ----- -,---._._.__ __ ;� Seller Descriptfon Borrower/Buyer �� Deb(t Credit Deb(t Credit 20.73 non-advalorem @ 62.00 per 1 year(s)9/Ol/2016 to 20.73 � � I12/31/2016 I I �� Loan Charges to Universal American Mortgage I Company LLC I I Deposit With Lender:Universal American Mortgage • 425.00 I I Company LLC I I Processing Fee:Universal American Mortgage 420.00 I Company LLC I I Underwriting Fee:Universal American Mortgage 450.00 I I Company LLC I 1 Appraisal Final Inspection:William Allen Moores 150.00 Sr. I I II Mortgage Ins.:FHA 0.75 II Mortgage lns.:FHA 1,653.00 II Lender General Credit:American Integrity 45,00 II Homeowner's Insurance:American Integrity 1,771.00 �I II Other Loan Charges II Appraisal:William Allen Moores Sr. 470.00 II Flood Certification:Corelogic Flood Services 7.50 �� 'I Impounds Homeowner's Insurance Reserves for 3 month(s)@ 442.74 II 147.58:Universal American Mortgage Company LLC I I County Taxes Reserves for 12 month(s)@ 186.25: 2,235.00 II Universal American Mortgage Company LLC I I Aggregate Adjustment Reserves:Universal American 442.75 I I Mortgage Company LLC I I �I I II Title Charges&Escrow/Settlement Charges � II Settlement Agent Fee:Buyer's Title,Inc. 861.00 652.50 Owner's Premium$115,500.00 for 115,5Q0.00: I Buyer's Title,Inc, I I 25.00 Loan Policy Coverage$96,153.00 for 96,153.00: I Buyer's Title,Inc. I I II Title-Abstract/Title Search:Buyer's Title,Inc. 250.00 275.00 Seller rep/closing coordination fee:Buyer's f 1 Title,Inc. I I .K�y� � �, y� CI pyright 2015 American Land Title Association. 16-4747 I rights reserved. Page 2 of 4 Printed on 09/Ol/2016 at 12:32 PM --�-------_..._._.__...._..._-----------—-------.._. � � _..v_._�._.�_.____..____ —_—_ --- � � i ;� Seller Description Borrowe�/Buyer ;� Debit Credit Debtt Cred(t �I 67.75 Title-Endorsement FF9:Buyers Title E Recording I 25.00 Title-Endorsement 8.1 for 96,153:00:Old I I Republic Nationai Title Insurance Co. I 3.28 Statutory Surcharge:Old Republic National Tit1e � Insurance Company I II II Commission , 2,887.50 Listing Broker Gross Commission:BHHS Florida IProperties Group I II 125.00 Listing Broker:Tech Fee 3,465.00 Selling Broker Gross Commission:Bingham Realty, �Inc. I I II II Government Recording and Transfer Charges II Deed Recording Fee:Buyer.s Title E Recording 18.50 II Doc Stamps(S):Buyers Title E Recording 808.50 II Mortgage Recording Fee:Buyers Title E Recording 146.00 II Doc Stamps(B):Buyers Title E Recording 336.70 II Intangible:Buyers Title E Recording 192.31 II II Miscellaneous 85.00 Curative/Post Contract Municipal Search Fee:Lien 85.00 Search Professionals,Inc I I II Survey:Target Surveying,LLC 340.00 �� Seller Borrower/Buyer �� Debit Credit Debit C'redit II 8.938.68 115,645.73 Subtota[s 126,158.73 99,518.40 II Due From Borrower 26,640.33 II 106,707.05 Due To Seller I 115,645.73 115,645.73 Totals 126,158.73 126,158.73 ��K � �� Qopyright 2015 American Land Title Association. 16-4747 dIl rights reserved. Page 3 of 4 Printed on 09/O3/2016 at 12:32 PM — _� —.---------__,____ _ -- --------_.___-----------m.T.------ � ----- --- ---- i Acknowledgement We/I have carefully reviewed the ALTA Settlement Statement and find it to be a true and accurate statement of all receipts ar�d disbursements made on my account or by me in this transaction and further certify that I have received a copy of the A�TA Settlement Statement. We/I authorize the Buyer's Title,Inc.to cause the funds to be disbursed in accordance with this st�atement. K��D K o �,� F deral National Mortgage Association a/k/a Fannie Mae Karl D.Kingery � �� Fay 1.Kingery z Miranda,Escrow Officer HIS IS A FINAL CLOSING STATEMENT �I'opyright 2015 American Land Title Association. 16-4747 t�rights reserved. Page 4 of 4 Printed on 09/Ol/2016 at 12:32 PM --___--- ---- - ------- - ------------- ----- ---.___.._ I --�.___ .__.. 1 I . ` I � � � � i I 16Pr�pared By: David W.Leskar,Esq. Buyc�'s Title,Inc. 100 NW 70th Avenuc Plan�ation,FL 33317 incidental to the issuance of a title insurance policy. File Number: 16-4747 Parcel ID#: 11-26-21-0010-07800-0090 57.]4�19th St,Zephyrhills, FL 33542 SPECIAL WARRANTY DEED (CORP0�2ATE) , This SPECIAL WARRANTY DEGD,dated this ist day of Septeenber,2016 by Fcderal National Mortgage Association a/Wa Fan �ic Mae,a corporation organized and existing under Ihe laws of the United States of America,by Buyer's Title, [nc.,as � Atto�ney-in-Fact, whose post officc address is: P.O. Box 650043, Dallas,TX 75Z65-0043 hereinafter called the GRANTOR,to Karl D. Kingery and Fay 1. Kingcry,husband and wife.whose post oflice address is:5714 191h St,Zephyrhills, FL 33542 herei�nafter called the GRANTEE: (Whi�rever used herein ihe terms"GRANTOR"and"GRANTGE"include all the panies to this instrument and the heirs,legal repri sentatives and assigns of individuals,and the successors and assigns of corporations.) WI INESSETH: That the GRANTOR,for and in consideration of the sum of$10.00 and other valuable considerations,receipt whe�eof is hereby acknowledged,hereby grants,bargains,sells,aliens,remises,releases,conveys and confrms unto the GRANTEE, all t at certain]and situate in Pasco Counry,Florida,viz: Lots 9, 10 and I 1,Block 78,CITY OF ZEPHYRHILLS,according to thc plat thcrcof,as recordcd in Plat Book l,Pagc S4,of thc Public Records of Pasco County, Florici:i. SUBJECT TO covenants,conditions,restrictions,reservations, limitations,easements and agreements of record,if any;taxes and ' assessments for the year 2016 and subsequent years;and to all applicable zoning ordinances and/or restrictions and prohibitions impqsed by governmental authorities, if any, �� TO i ETHER with all the tenements,hereditaments and appurtenances thereto belonging or in any�vise appertaining. 1'O I-�AVE AND TO ROLD.the same in fee simple forever. AND THE GRANTOR hereby covenants with said GRAN"1'EE that it is lawfully seized ofsaid land in fee simple;that it has good, righ{and lawful authority to sel!and convey said land;that i1 hereby Cully warrants the title to said land and will defend the same against the lawful claims of all persons claiming by,through or under the said GRANTOR. �� i�� - � �� w�� Page 1 of 2 � ---.�.-----------.--.---...___ ___,._.__._ r__— � , .. - .. � - � i �i��tilllllllfllllllll1111111111111111111illllliliillllilll Y , 2016139849 ( Key Rto_ P.ermit i�o, i �cp{,:1798582 Ree: 10.00 RiQT1.CE.OF COMNtE�tICEMENT . D5: �l.00 IT: 0.00 C1erk i 09/06/2016 K. D. K. , �PtY 3'l�iE, it4D�RS3{3l+IEC!ltBFeby,�iVBS 110tiCe U"!8t ittlp�Otre�#o±s�.�tri(t hr� pRULA S 4'NE iL�Ph D.PASC4 CI.ERK & CQMP7ROI.LER Mad�to certaiti,and in accariiarice with Chapfer7t3,•Fforida.Sfate - 09106/201 9:4 am 1 of 1 Statues,thefoltouving�ir�formation•ispravided•inttiis:Notice.of OR 8K ��2� PG 4�� , Comll encesrterst — ---. - � _. -- � 1.Description.of'�cope►^�y:�Parcef Na.:. .��.,�I o��v�~o�-j - UOtb D��pp - CS4 '�'!C5 .{�egal descriptian of�t�e�property-anr3 stree#address if available� " - 2. �G��G Gal Eescription of Improvement I `` C �) �E'�.f �,; r� �'i.� .vt �r R-,r1 c� NC�l J��f14 3. Ctv�mer Irifamaatian:Name: � A�dd� �^'' / /�,�� [.{.�, ,��w'�s�y/�'/.., ress:S'�I/� �� tiJ�}�+�� - VIE� � r JlP.tr ��7�c�vy�`--�..! interest in Pr.opeity: . ��-..._ -:5-:a"�!a.��^��.��;��:T�2holder.(ff�ot�erthah.ovurierj: . . 4_ Cantraetor.. Name;�TLC�RtJOFti�1G LLC ... . . . . . ... . . .. . o Address: PO EiOX 1•7.45 �.. . ..'" . .. City DADE ClTY �:' � State FL 2ip 33�26 :.�hone�t�o. 352=473-�4Q73 � . F�xx�fo..=352=.473=4Q73 5_ SureEy: Name� � Amount of�8ond:$� . Address: .. . Citjr_ . . � . . . .. . State ...,�T�rp. . Plione.No. . . ... . . . . Fait No. . 6. �ender;iVam�: .. . . . . . . . Address: . . Cit�r S�ate,,_�'tp Phone No_ � � Fax No. 7_EP'ersans w�#liin•tfle StaY+e�of�F(osida desTgnated by Owiie�upan wtioin nr�fices or otEier documents+may..be �ser�ed as sroiride�by Section 7'i3:�13(1.}(a}(7) �forida�Sfatutes. jName: � �Address: .. .Ci�y Sta�e�,_�ip �'hone:�No. . � . . . F.ax No. � 8_(tri additian fo himss€f.•or herseif,C?wner-ac�ig�a#es � � � of o receive�a copy of the Leino�s.Notice as provided�in Section 713.13(.'t),(b),��lorida Statutes. .9.Expira�ao date of i�at�ce of Gominenc.e.ment(the-ex�iratian.date:is�9 year r�f recording untess a different date is specified.) , ! Sikt Nlt�tG TO.QY4FNEfZ:AHY PQYMENTS @1lA17E oY Tk!&G�i:Si�.'.^.�,`^-.`+.+,'{'::�.."�"'.+_."'.:'..^„S:r".:4:::""':i:,lti:;::t'.r tlt'COHlI18ElYCEDAENT:4ftE ' CG�NSiDERED tRRPR4PEB�PAY�TS llNDEEi CHAPT£Ft7t8t PART't,SEG7s3:�93,F�.ORIi}�.STATUiFES,ANi}Gi�N#tESt3}�T 1N Yt}UR P/�YING°11MCE EOR.I(VlPRQVEMEN'f'�TO YQUR PROPER7Y,74�NOTtCE OF G0�9MlEM110E'lYfEl`�TT IlAUST BE RE�C7RDED AND PQSTED�ON THE JO�F3 S{lE B�EORE TNE-FlR571HSPEC;iION.IF YDU�•IWTEND 3'O OBTAIN PIlilpi�iCINQ,.CONSULT{MLTH�YOUR LEIVDER OR AYi A IY�RNEY 3ervn�.:vanF1lz:vv:ii�titiv.:.:::i.:�:.^.:I"s.�.::i:...::»3::::::�i:.;:iCsFi.sai-««.tYt`.'+iT. -, I �1K � ��, , . . .. . . � � _8ignafuu�of`O+�sneror0'vd �r�QfficerFDise�torlPat6te�fMatiager Sigrtatory's.T�ttetOffice I 'i''ic-£;v:i�::��_::=a_+_�..__"t?iR!�`�'�118[{'.'c � st�t�of �l.o R�.�S� ca�n�y� QR 5�.a �I e forgoing instrumerrt w�'s:ada►avutedged before ine this�� day of�Q$^,.,20�tiy . Ka�� o��ua . �Cn w c�.¢,f�r. I i 1 '{Printed�iame of p�rson aciviarv�Aed ngj SS �n iro.sy! {OC �4a� ( a v { (i`ype of audrariry g„office,6r,usCee,attomey in fad) (fVame of paity on;tietiaff of ., o inshumen e . ��!`1GL� !r"`"L�'� a,u,,,y� . � S��re of N Prirrt ' .... r° P'ersonaliy knovm OFt Pioduced�lclentifrcatian x �',• . _�c� �"'-`§��aa "�- Commission.�FF 969450 I �ype of Ider�ifscation Produced: �t �cs. �s..�x,. .� %�, a:= �--i •,;�oF��';c Nly Camm.Exp3res Jun 27,2020 1�edficaQion pursuant to:Settion'92625,Fiorida Statutes:under Penakies of perjury , t the faets .�ww1 iit{t?dne t[uB t0 the bBSt of c[!y'ltsiOWlBdge a[td.be!!ef , ' - � � ' . � �eS��e STATE OF FLORIDA, COUNTY OF PASCO �� 0 � � � '�� THIS IS T0�CERTIFY THAT THE FOREGOING IS A � ��, � � � TRUE AND CORRECT COPY OF THE DOCUMENT ' ON FILE 0�OF PUBLIC RECORD IN THIS OFFICE WITNESS f�Y HAND AND OFFICIAL SEAL THIS � s rn?a��e T.-�u,r o * �DAY OF� i 2 6�,�a � • ��.c � PAULA S.O'NEIL,CLE K&COMPTROLLER I ^ � • � = i��7 � gY � � �'�-` ,DEPUTY CLERK ��o��`�� j 813-� eo-ooZa City of�ephyrhills Permit Application Fax 813-Tso-ao2� , 8ullding Department •, • ` . . Date Recelve,d� .-: phane=Contact�far�ermlttin ' – 4wner's Na II Qwner Phone Number ,, . - Owner's Add ess �-! � ��• � Owner PhoneNumber � � Fee Simple tleholder Name � Owner Phane Number �� 3' ' � Fee Stmple T tleliolder Addr�asa � • JOB ADDRE S LOT# �__,� SUBDIVISIO �— � P�ARCEL.ID# � " �U '. f°-'C��¢. t7~ (� �� —�� , (OBTAINED FROM PROPERTY,TAX NOTICE) WORK PRO G1SfD� •,NEW CONSTR � ADDIALT � SIGN' `[� Q DEMOI.tSH �;��. INSTAI.L �', REPAIR Pl20Pt}SEDrI $E . ' [� SFR Q 'COMM C� �OTHEF2 � TYPE OF C0� STRUCTION Q ' •�BLOCK `" � FRAME [�� STEEI. Q DESCRIPTI N OF WORK, . . c.�-�J� d Z�� {��-� �� BUILDING SiZE �^' � SQ'FOOT/lGE ` � , '.HEIGHT��C�� I ��d��'' $ C� VALUATION:`�7F TOTAL CONSTRUCl'ION , ` , ' � S QEt.ECTRIGAL � � AMP SERVICE. 0 PRfJGRESS ENERGY Q W.R.E.G. QP,i�l3MBtNC3 $ -, - I � �� , QMi CHANICAL $ ' VALUATION OF.MECtiANIGAI IHISTALIATIt}N. ; Q�S Q . ROOFING Q SPECIA�.TY �� OTHEFL FINI$HED FILOOR ELEVATI4NS L� FLOOD ZONE AREA QYES ,NO f � - BUILDER ��-Z� COMPAfiIY'� f t. �3Z3 ft1 SIGNAI'UR �' REGISTERED Y/ N FEE CURRE� Y'/N Address � � Llcense# �� tECTRICIAN . .'COMPIINY - , ` SIGWATUR,� `� REGISTERED Y/ N FEE CURRE�'' Y/N , V l�,ddre s . License# PLt1N18ER I~_ COMP..ANY � SIGNATUR ` ` REGISTEREp Y./;N FEE CURRE�' Y�/N. Addre ' Ucense.# � .�- :' = 1� i MECHANIC�41:' ' � ' � f COM.P.At�tY SI(3NATUR�� - gEGIS7eiiEp Y,/ N ; FEE CURRE� Y,/N Address` z , . � �. � � .� ' = License# �� I _ OTtiER I: _,, ` . . ` .'COMPAI�iY , Y . � . SIGNATUtt� "�� •` ' - ' �' REGI$TERED Y/ N..- FEE CURREk Y/N , Address, , ,. ^ . . , License# � �� i REStRENTIAL,;'- ,�Attacti`{2),PlottPlaris;�(2)set`s`:af=8uilding�Plaiis;'{'I)setof'Erisrgy=Faims;:F2=0�W`Peris►itfornewconstrqc�an, _ " , Minimumsten�(1,0).;wo,rlcingrdays,'after,_subirittital'date.:-R'�quired onslte,:Constru'ctlon Flans;`Stannwater Plans w/Silt Fence instalied, x� ��.:-Sanitary Fac{IIUes,.&�.1;dumpste,r,,Slt�-Wa�Ic;Permihfcr subdivislo`ns/largeEprnJects_. .:, ,_ � : , ', -._COMN9ER_,IAL Attach{3)eomplete'sets of'8yilding"P1ans�plus a Cife�Safety�Rage;(1}se#of Energy Fotms.Ft-O-W Permlt far neuv construGtiao.- � Mln(mum ten(10)working days efter submittal date. Required onsite,Construcdon Plans,Stormwater Plans w/Silt Fence installed, wanitary Faciti8es 8!dumpster.Site Wosk Permit for all new>proJec�::All commerclal requlrements.must meet compllance 51f3N PER�tiT Attact►'(2)sets of�Eng,i'n�e[ed:.Pians:;.� ;�-=- ��_ _ .. � ` - II ""'•PROPERTY SURVEY reguired for,all NEW construction.. .. „ , Dirpations'i �..',�.,w_:}_.-. : . . _ . FIII ou�applicadon completely. t�wns�&Cantractor sign back of appitca�on,no�dzed � If ove �52500,a Nottce of Commencement is reqWred. (AIC upgrades over S7S00} .Y��C.�; " Agent��(for the'contractcir)or Pbwer ofAttbmey"(for"ttie owner)"would be someune with nota�ized letter from owner authorizing same QVEFt'TH �COUNTER:PERMITtING�- •�- (Front•af-Applfcation•t3nly}•� • Reroafs if s ingles Sewers Service Upgrades A/C Fences(PlodSurvey/Faotage) � Drive) aya-Nat over Caunter if on pubiic roadways.:need's ROW ' � A ' I ► ' _` •�k., �'+. NOTICE OF DEED RESTRICTIO.NS: The undersigned undetgtands�,th�t;this;p�rmit.may.be,sub)ect to,"deed"rest�ictions° ._ .r.�., which may�be=more�."r.est�Ictive=tha��County��regrilattons:��The`undersigned agsumes°responsitilltty#or�connpllanc�uiritFi°any � applicable.deed restrictions. . ,. : �,; ; -- - : � _ . : . ,.._ ; � =_ ` .- -. UNLICENSED�.CONTRACTORS AND CONTRACTOR RESPQNSI@ILITIES: -If the�owner has fitred��a"contractor or . �'� _ � . . . . . , - contractors to undertake work, they may,be,ce�quired_to.:be_Ilcensed In accordance duith state�and,local,_regula4lon.s..� If the- � contractor ts-not Iicensed as�requlred�tiy lew� botFi�the'owner and-contractor{may�be°°clted�for-�a�misdemeanor vtolatlon under state Iaw. If the owner or Intended;contr;aetor are;�ncertain as to what Itcensing:.requlrements:may:sappiy--ior�the�� -°_=-- �' ,�.,,.. -.. ,_�. . .�. „ - .,.. . __A� _ . . �.. intended work, they are_advised to coritact the Pasco County;Building'Inspection_DIvlslon--Ltcensing Sectton at 72T-847- 8009. Furthennore, if the owrier'fias�Nired�a con'acfor�o� contrectors, he is advtsed to have the contractor(s),sign �,:.� portlons of the°contractor Block" of this_application for which.they wilt be tesponsible... If:you,.as�the owner:sign�'as the" ' contractor, that�may be an indication that�lie'is not properly licensed�and`�is not"entitled to permiEting privileges in Pasco ; County. � - �:�:.-. . ,- _ .: 'fRANSPORTAT10N�tIYIPACTIUTILITIE$�rAAPAC7�ANb RE30URCE RECOVERYfEE3:�T�he�undersigned unde�stands thatTransporta�tlon Impact Fees and.Reco.ur�e RecoVery.Fees mey�:apply�to�-the;construction;of_new bulldtngs,��.change��of`�=` �--�-� use In existfng buildings,�or,expansitin.•of�"ei�istin,g:-�fiuildings, as specifled.tn Paeco County Ordinance number 89-07 and 90-07, as amended...,The undetsigned also,understands� ttiat"suoh fees,-�as�may_��e�jdue;�wiil::be idenftfied at the�time'"�of�� '�-�' permitting. It is fu"rtFier understood that Transportatlon impacf Fees and�;Resource Recovery�Fees.mu'st be paid prio�to receEving-a °certiflcate:of-occupancy"�or�flnal�power;release: :If��the.project;.does:not Involvera;:certfficaEe of occupancy=or°`=s=��--= "` flnal power'release�the:fees-mu�t�be paid,pcior to;permit issuan'ce. Ft��thermore;°if Pasco,�County}WaterlSewer::Impact .�� ._ �, � fees are due,.they_must be=pald..pi�idr to permit;issuanee;in.accordance wit��applicable Pasco��County ordinances. • CONSTItUCT10N"GEN`�LAYII"(Chapter 713� FloHda 3tatutes�as amendid): If valuadon of work is$2,500.00.;or more.,-I�� : --.� certify that -I,.the. applicant,-have..been .provided �with-�a-�copy-��of�:the;"Florida��Constructton��Llen :Law—Homeowner's Protection Guide" prepared by,the Flo�ida Depertment�of Agricultnre and Consumer Affairs. If the appl(cant Is someone- _. , .. � other than the°owner, I certify�-that i;.h�ve.,obtained�a`�copy,of the`:abave:desc�ibed.�focuri�ent-and�.plomise;in,good:faith to _ . deliver It to.the.<'owner":prior'to�ciommencement:�'�` � "' � � � � `" ' �3• � � �- ' - . , CONTRACTOR'S/OWNER'S AFFIDAVIT: 1.certify,:,th�t.ail.the,,information;in:thi�appllcatlon is accurate.�nd that all work wili'be done in compltance wlth all.appitcable�laws reg�ilating construction� zoning �nd•land development. Appilcation,is hereby made to obta(n�-.a:permit:=,to:do.,�w�r.'k;;and:liistsllation as indi�efed:�.:��1. cerlffy that no work�or Installation has'� commenced p�tor to Issuance of�a permif""and that:all work wlll be pertormed�to meet-standards-of all laws regulating- i construction, County and City codes, zoning regulatiQns, and land development regulations-tn the .jurtsdlction.• I al'so ce�tify that I understand that the regulations of other government agencies may�apply�to the intended work� and that it is my responsibility to identify�what.act(ons I must•take.to,be,ln;compllance;�Such:agencles include but�are.not Ilmited to: � - Department of Envlronmental�Protectton=Cyp�ess''Bayiie"ad9, WeNand Areas and Envfronmentally Sensitive Lands,WaterNVastewater Treatment. � � - Southwest Florida Water Management':District-Wells,''Cypress.`Bay.heads; Wetland Areas, Altering Watercourses. � - - - Army Corps of Engineers�Seawalls, Dacks, Navigable Waterways. - Department of-Health:'8. .ReMabilitative,Servtces/Envitonmental;�Health Unit:Well.s� Wastewater=Treatment, � Septic Tanks:. - -_ ' _._ � � - - US Environmental Protection Agency-Asbesto�abatement. _ - - Federal Av,latton.Authocity:Runways. � � " I understand that the.followtng;restrictions apply to tiie use of flll: - Use of fill is not allowed in;Flood:Zone"V"unless expressly permitted. ' - If the fill materlai`=1s to�"be used:ln-�flood Zone. "A", It. Is understood-that a dra(nage plan addressing a "compensating volume" will be submltted at time of�permittJng wfiich ts prepared by a professional engineer � � Iicensed by`the State`of'Florida: . � �� -. , -� - - -If ihe flll�matertal�.ts to.be�.used In Flood Zone 'A° in�connec�ion�wlth�a�permitted buflding using stem wall � construction, I certity that flll�:virlli=b.e�used only.to fill the area w(thin�the�stem�wall. - If flll materlal is to be used In any area;�l��certify that .use of such flll will not adversely affect adJacent propertles. If use of flll Is found_to adversely:,�ffect adJaeent�properties,.the owner may be cited for violating. the condl�ions�of the building'.permit�I§sued�under tFie:attached_permit �pplicatlon; for�lots^less than:one (1) acre whicfi ere elevated�by fJil,��t engineer•ed drainag�plan is required. If I am the AGENT-.FOR,THE OWNER; I�promise In_good_fatth to inform the own�r of the permitting condftlons set forth in thts affidavit�prior to commeraoing construction. �i understand that a:separete permlt may be requl�ed for electrical v�rork, , .,... .�.. plumbtng, signs, wells,.pools;. air condttiontng,.gas,�.;or..othe� install�ttoris nol•spec�ically included�in.the�application. .A � permit Issued shall be constr.ued to be�a�'liaense`�to:�proceed with`tFie_work and,.not�as.:authority::to.vlolate;'cancel. alter, or ' set asfde any'provisions of the.technical c�ndes;�nor shall issuance�of a.permit.prevent the�uildirig Ofiicial from thereafter requiring a conection af enors in.plans;:constiuction,or vlolattons of-any codes. Every�perm(t issued'shall-become inval(d unless the work authorized:by such permit:ls.commenced•wlthtn sGc.mAnths of permit issuance, or if work authorized by the permit is suspended or..aba�doned:for,.a�:period.,of�six:(8)�montfis.afte�the;time the�wotk�s commenaed. An extension may be requested,.in writing, from tFie'Bullding,Officlal for a per(od�not-to exceed ninety(90)�days a�d�will demonstrate justiflable'cause for.the extenston: If work ceasea.for ninety.(90)cons.ecutive:day.s...th�)ob�is.considered aba�doned. WARNING TO OWNER: YOUR.FAILWRE�TO..REC.ORD.A:;MOTICE:OF:�COMM�NCEMENT;MAY=RESULT IN�YOUR PAYING TWICE.FOR IMPROVEMEN.�'$�TflXOUE�:PR�OPERTY.��IF°YO.U{IN�EKID��TO''nHTAiN��FINApEfNC�;'C:ONSULT WITHY�UR�LEND�R�ORAN°ATTORNEY�EPOR��RECORflI(�lfi�l(OUR'NOTICE'�F'COIIAMEN EfVIENT' FLORID.4 JURA�(F.S: 117.03)•------- -- —-- �- - - _ -. ... --- -- - .. -_ --_ -- --— - --— - OWNER OR AOENT CONTRAGTOR � � Subscxlbed and swom to(or aHirtned)before me this Subecvibed and'swom•to(ot aflirmed)�before me fFii§ by ..by.._ � Who Islare personally knovm lo.me or has/have.produced Who.le/are p.ersonaliyknown•lo me or haslhave�produced- ' ae Id"entlflcatlon.- as IdentlflcaUon. Notery Public � Notary Publlc Commission No: Commisslon No. • Name o1 Notary typed,printed or stamped Name of Notery typed,pdnted or stamped